Segment Location and Ground Glass Opacity Ratio Reliably Predict Node-Negative Status in Lung Cancer
| Autor: | Haiquan Chen, Yuan Li, Fangqiu Fu, Zhexu Wen, Lin Deng, Shengping Wang, Yang Zhang |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Pulmonary and Respiratory Medicine
medicine.medical_specialty business.industry medicine.medical_treatment 030204 cardiovascular system & hematology medicine.disease Ground-glass opacity Metastasis 03 medical and health sciences Pneumonectomy 0302 clinical medicine medicine.anatomical_structure 030228 respiratory system Mediastinal lymph node medicine Carcinoma Surgery Radiology medicine.symptom Cardiology and Cardiovascular Medicine business Lung cancer Lymph node Inferior Mediastinal Lymph Node |
| Zdroj: | The Annals of Thoracic Surgery. 109:1061-1068 |
| ISSN: | 0003-4975 |
| DOI: | 10.1016/j.athoracsur.2019.10.072 |
| Popis: | Background Although selective mediastinal lymph node dissection based on lobe-specific nodal metastasis has been proposed for non-small cell lung cancer, controversy remains over its validity. We hypothesized that different segments within the same lobe might have different patterns of lymph node metastasis. Methods Data on 2749 invasive non-small cell lung cancer patients who underwent pulmonary resection with systematic lymph node dissection from April 2008 to December 2015 were retrospectively analyzed. The segment location and consolidation tumor ratio were identified using preoperative computed tomography scans. Results None of the 151 tumors with consolidation tumor ratio ≤ 0.5 had lymph node involvement. None of the 333 tumors located in apical segments had inferior mediastinal lymph node metastasis. When the analysis was limited to patients without hilar nodes involvement, only 7 out of 740 (0.9%) peripheral upper lobe tumors had inferior mediastinal lymph node metastasis. Interestingly, all these 7 tumors showed visceral pleural invasion. If hilar nodes were negative, superior mediastinal lymph node metastasis was not present for lower lobe ground glass opacity lesions. Among patients with left lower lobe tumors, if hilar nodes were negative, station 4L lymph node metastasis was not found in superior-segment or basal-segment tumors, and station 5/6 lymph node involvement was always absent in basal-segment tumors. Conclusions Segment location, ground glass opacity proportion, and absence of hilar lymph nodes involvement are reliable predictors of node-negative status in specific mediastinal regions. Based on these findings, we propose a new selective mediastinal lymph node dissection strategy for non-small cell lung cancer. |
| Databáze: | OpenAIRE |
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